Electronic health record systems for everyone in South Africa are on the way.
At least one might gauge this by the reaction to the State Information Technology Agency’s (SITA) request for proposals last year, on behalf of the Department of Health.  This aroused the interest of almost all major IT players in healthcare along with the interest of many small suppliers, writes Terry Stew, business development manager at Fujitsu.

Due to the magnitude of the undertaking and the commercial risks involved over the long term, the established suppliers are likely to stay the course with smaller suppliers likely to join forces with them to provide the best combined solutions and spread the risks appropriately.

One has to look at the winners in the overseas healthcare market such as Fujitsu and Accenture to recognise that a system like an eHR (an Electronic Health Record system) is usually supplied by a company with the financial strength and experience to deliver such a complex program – in the context of healthcare reform that is underway around the world.

Why is it so complex when it sounds so simple? After all, other industries such as telecommunications and financials services have all fully automated their internal operations and their interactions with clients? Whichever country it is, the healthcare industry wants four fundamentals: ‘improved access to health care’, ‘improved quality of care’, ‘preventive and promotive health’, and ‘better efficiency’.  In other words, better healthcare for the same or lower costs. South Africa is no exception.

The problem is that the healthcare industry has been slow to agree on best practice clinical and administrative processes.  The evidence is all around. There is no single healthcare approach, let alone a system that can be truly proffered as a proven template for any country wanting to reform its healthcare processes and enable them with technology, yet the recognised benefits of reform and automation are just about the same.

According to Fujitsu, the four fundamental requirements map directly onto the four major dimensions of change for any healthcare reform program. Fujitsu, who is currently implementing a major healthcare program in the United Kingdom and who developed a ‘sustainable healthcare Program’ for Canada, interpret South Africa’s requirements as ‘improved access to health care’, ‘primary care reform’, ‘best practice process and health care solutions’, and ‘cost reduction’. In other words, no difference.

Fujitsu believes South Africa is unique but has similarities with Canada. Canada, like South Africa, has established hospital and primary care systems in place which it wants to keep, but needs the information held to develop a central eHR records system.

Information covering a patient’s specific experience such as a diagnosis and subsequent operation, known as a ‘Clinical Careway’, stays put in the hospital system. However, essential information is sent to the eHR and a historical central record is created. To get the information into the eHR properly involves a tricky issue known as ‘integration’ and that’s part of the complexity.

In terms of similar projects overseas, the United Kingdom took a different route and essentially implemented a standard ‘Clinical Careway’ system to ‘double up’ as both a hospital system and eHR system.

All hospitals in each UK ‘region’ are required to adopt this system as a standard, thereby forcing a high degree of standardisation across the region and, in turn, the country. This is enabling clinicians and other healthcare workers to have to update only a single patient record from the outset.

Both the British and Canadian approaches introduced major changes in the way healthcare workers operate and in the way patients are dealt with. Fujitsu unequivocally believes that it is the management of this change that is the most important requirement.

This is more important in fact than the technical system itself because people’s lives are at stake and getting clinicians, whose  primary job is to improve the quality of life, to change the way they work smoothly, harmoniously and with least disruption is a major challenge.

Fujitsu meets these change management challenges head on. Their first priority is to get a management structure in place that involves every interested party in eHR, including clinicians, to agree a change program.  The right amount of training at the right time, explanations and agreement on the plan – all aimed at getting all-round acceptance.

The next challenge is being able to recognise some measurable benefits from the program as the project proceeds. Not some overall ‘pie in the sky’ target at the end of the program but something measurable on a step-by-step basis that defines the successes at various stages of the program.

According to Fujitsu this can be done at an individual ‘dimension level’ such as improving patient access to healthcare or a lowering of costs. Fujitsu says it has the proven tools and methods to achieve this – and a string of individual sequential successes is far better than waiting in hope for some massive ‘tick in the box’ at the end of the project.

None of this seeks to skip over the importance of the technical solution that must meet the requirements of each individual country. Fujitsu says South Africa’s statistics are fascinating and include some salient differences when comparing us with, say, Canada.

For example, the South African Government spent 8,2% of its GDP on healthcare in 2004/5 (approximately R114-billion), yet this represents only 40% of the total healthcare spend. The public sector provides services to 80% of the country’s 47-million citizens. This implies that 60% of the money spent on healthcare is used to service 20% of the population.

The ratio of private to public sector expenditure per head in 2005/6 was 6:1. The South African public sector is clearly under-funded and over-utilised. But then, this is the same in a number of other countries. Even in the richest and theoretically most developed countries, access to quality healthcare is a major issue.

The case for making our healthcare IT systems more efficient is therefore overwhelming.

In South Africa, providing access to services is further challenged by the geographic distribution of the population. Approximately 50% of South Africans live in rural areas. This makes providing access to healthcare difficult. One way of keeping the information in one place for an individual is to put it on a card system– a ‘smartcard’. These can be read electronically when a patient goes to a hospital or clinic.

Fujitsu believes South Africa must continue to invest in improving its IT infrastructure across the country in order to reach the capacity required to support the transfer of information around the country that is needed to support a successful central eHR. The company believes this is a major reason for providing local eHR systems in the provinces in support of a central eHR repository.

The central repository will provide national statistics on national healthcare problems like the increasing prevalence of HIV/AIDS and tuberculosis. In 2005 it was estimated that 13,3% of women and 8,2% of men were HIV positive.

The funds allocated to these programs need to be agreed against reliable statistics and trend patterns across the country if we are to tackle these scourges efficiently. Statistics from a good eHR system will facilitate this among other serious issues such as the surge in the prevalence of chronic diseases like strokes and diabetes

Another unique challenge in South Africa is establishing patient identity – given the preponderance of similarities and nuances in our names. Identifying the right person quickly when searching for medical information is absolutely key if the system is to be trusted by everybody who uses it. Fujitsu believes the right ‘search mechanism’ (that is, something fast and accurate) built into the eHR is fundamental to it ever being accepted.

So, the ‘eHR.za’ is complex but SA is in a good position to learn from the lessons of other countries and get it right. By taking a pragmatic start point, and focusing on clinicians and change, rather than technology, South Africa could become a showcase for the rest of the world.